Correlation of CD4 counts with clinical and histopathological findings in disseminated histoplasmosis: a 10-year retrospective study

Abstract

Background

Disseminated cutaneous histoplasmosis (DCH) is one of the manifestations of systemic histoplasmosis infection in HIV-positive patients. Interaction between host immune status and histoplasmosis infection is still poorly understood. It is thought that immune status, represented by CD4 counts, may be correlated with clinical and histopathological findings.

Objective

To correlate the CD4 counts with the different clinical and histopathological findings in cutaneous histoplasmosis.

Methods

This was a serial case report of seven HAART-treated HIV positive patients with disseminated histoplasmosis observed within the period of January 2004 through December 2014 from the Dermatology and Venereology Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The patients came with different complaints and clinical findings. CD4 counts were recorded prior to lesion biopsy.

Results

The CD4 counts were independent from clinical morphology and distribution of lesions. Lower CD4 counts were associated with the presence of intraepidermal yeast-like cells, whereas there is the ability of forming granulomas at higher CD4 counts.

Conclusion

CD4 count correlates to histopathological findings of cutaneous histoplasmosis.

http://ift.tt/2sEuor6

Health anxiety in dermatology

http://ift.tt/2tnV4ZZ

Topical timolol for treatment of penile Kaposi sarcoma in HIV-negative patient

http://ift.tt/2tfi6DT

Riga-Fede disease in the upper jaw in an infant

Abstract

Riga-Fede disease is a benign and uncommon mucosal disorder. This illness is an ulceration of the oral mucosa and arises from repetitive traumatic injuries. The disease is usually caused by the sharp edges of new erupted teeth. The aim of the present case report is to present Riga-Fede disease and its treatment. We reported a 11-month-old healthy female infant diagnosed as Riga-Fede disease based on clinical features. After the conservative treatment that focused on eliminating the source of trauma, total healing was observed. Riga-Fede disease is rare. This illness can be confused with malignancies. Therefore, the diagnosis and treatment of this disease are very important for physicians and patients.

http://ift.tt/2sKJ3Mz

Superiority of a vitamin B12-barrier cream compared with standard glycerol-petrolatum-based emollient cream in the treatment of atopic dermatitis: A randomized, left-to-right comparative trial

Abstract

Atopic dermatitis (AD) is a result of complex genetic, epigenetic, environmental, and immunological interactions with an overlapping epidermal barrier defect. The study evaluates the efficacy and tolerability of topical Vitamin B12-barrier cream (MB12) compared with standard glycerol-petrolatum-based emollient cream (GPC) used three times a day for mild AD. The study was conducted as a on one hemi-body randomized, controlled, single-blind, intra-patient left-to-right comparative trial by patients with clinical diagnosis of mild AD measured with total SCORAD index over 4 months. MB12 was compared on one hemi-body treated (GPC). The comparisons of score values were performed primarily by using non-parametric procedures: Mann–Whitney-U test (for independent samples) and Wilcoxon test (for dependent samples). All 22 patients were randomized (left or right side treated with MB12 or GPC). At week 12 a reduction from baseline in SCORAD index was assessed in both body sites with 77.6% SCORAD index reduction in the MB12 treated body sites versus 33.5% in the GPC treated body sites. These results suggest that MB12 could represent a new option in the treatment of mild AD.

http://ift.tt/2tfcGJo

Age-Associated Intracellular Superoxide Dismutase Deficiency Potentiates Dermal Fibroblast Dysfunction During Wound Healing

Abstract

Reactive oxygen species (ROS) impair wound healing through destructive oxidation of intracellular proteins, lipids, and nucleic acids. Intracellular superoxide dismutase (SOD1) regulates ROS levels and plays a critical role in tissue homeostasis. Recent evidence suggests that age-associated wound healing impairments may partially result from decreased SOD1 expression. We investigated the mechanistic basis by which increased oxidative stress links to age-associated impaired wound healing. Fibroblasts were isolated from unwounded skin of young and aged mice, and myofibroblast differentiation was assessed by measuring α-smooth muscle actin and collagen gel contraction. Excisional wounds were created on young and aged mice to study the healing rate, ROS levels, and SOD1 expression. A mechanistic link between oxidative stress and fibroblast function was explored by assessing the TGF-β1 signaling pathway components in young and aged mice. Age-related wounds displayed reduced myofibroblast differentiation and delayed wound healing, consistent with a decrease in the in vitro capacity for fibroblast-myofibroblast transition following oxidative stress. Young fibroblasts with normal SOD1 expression exhibited increased phosphorylation of ERK in response to elevated ROS. In contrast, aged fibroblasts with reduced SOD1 expression displayed a reduced capacity to modulate intracellular ROS. Collectively, age-associated wound healing impairments are associated with fibroblast dysfunction that is likely the result of decreased SOD1 expression and subsequent dysregulation of intracellular ROS. Strategies targeting these mechanisms may suggest a new therapeutic approach in the treatment of chronic non-healing wounds in the aged population.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tOVQ5j

Neurological and psychiatric associations in bullous pemphigoid – more than skin deep?

Abstract

In elderly patients, bullous pemphigoid (BP) is associated with several comorbidities; the strongest association occurs between BP and neurological diseases. Different types of dementia, Parkinson's disease, cerebrovascular disorders and epilepsy all have a significant association with BP but patients with multiple sclerosis have the highest risk of BP. An existing neurological disorder appears to increase the risk for subsequent BP, but an increased risk for developing some neurological diseases has also been reported following BP diagnosis. BP seems to be associated with several psychiatric diseases such as schizophrenia, uni- and bipolar disorder, schizotypal and delusional disorders, and personality disorders, but the risk ratios are usually lower than with neurological diseases. In addition to the skin, the BP autoantigens BP180 and BP230 are expressed in the central nervous system. This finding together with the strong epidemiological association between neurological disorders and BP has led to an assumption that neurodegeneration or neuroinflammation could lead to a cross-reactive immunoresponse between neural and cutaneous antigens and the failure of self-tolerance. A subpopulation of patients with Alzheimer's disease or Parkinson's disease have circulating IgG autoantibodies against BP180, but currently their significance for the development of BP is unclear, since these anti-neural BP180 antibodies neither bind to the cutaneous basement membrane nor cause BP like symptoms. Further studies analyzing large and well-characterized populations of neurological and psychiatric patients are required to understand better the role of autoimmunization against neural BP autoantigens in the pathogenesis of BP.

This article is protected by copyright. All rights reserved.

http://ift.tt/2uohx9p

Imiquimod-applied Interleukin-10 deficient mice better reflects severe and persistent psoriasis with systemic inflammatory state

Abstract

Previous studies have shown that imiquimod-induced psoriasis-like skin inflammation in mice resembles phenotypic changes and cytokine profiles of human psoriasis. However, a psoriasis animal model reflecting the chronic inflammatory course and comorbidities has not yet been established. We aimed to evaluate the imiquimod-applied interleukin (IL)-10 deficient mouse model in comparison to previous models. IL-10 deficient and wild type (WT) mice received either imiquimod or vehicle cream for 12 days and were sacrificed on day 15. For earlier time point data, either imiquimod or vehicle cream was applied for 2 days and the mice were sacrificed on day 3.

Imiquimod-applied IL-10 deficient mice showed more persistent psoriasis-like inflammation and higher severity index than did WT between day 8 and 15. Histopathologically, they demonstrated significantly thicker epidermis and larger number of CD45+, myeloperoxidase+, and IL-17+ cell counts on day 15. Quantitative reverse transcription-polymerase chain reaction with skin tissue revealed significantly higher imiquimod-induced IL-23p19 expression in imiquimod-applied IL-10 deficient mice on day 15. IL-10 deficient mice also showed significantly higher serum levels of imiquimod-induced IL-17A and tumour necrosis factor-α by enzyme-linked immunosorbent assay on day 15. Furthermore, IL-10 deficient mice showed more prominent increase of spleen weight and decrease of bodyweight in response to imiquimod application on day 3 and 15. In conclusion, IL-10 deficient mice model with imiquimod application may better reflect severe and persistent psoriasis with systemic inflammatory state.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tOzKjv

Ultraviolet radiation and skin mast cells: Effects, mechanisms, and relevance for skin diseases

Abstract

Mast cells (MCs) are well-known as versatile effector cells in allergic reactions and several other immune responses. Skin MCs and cutaneous MC responses are subject to the effects of environmental factors including ultraviolet radiation (UVR). Numerous studies have assessed the effects of UVR on MCs, in vitro and in vivo. Interestingly, UVR seems to have variable effects on nonactivated and activated mast cells. In general, UV therapy is beneficial in the treatment of urticaria and mastocytosis, but the effects are variable depending on treatment regimen and type of UVR.

Here, we review and summarize key reports from the older and current literature on the crosstalk of UVR and skin MCs. Specifically, we present the literature and discuss published reports on the effects of UVR on skin MCs in rodents and humans. In addition, we review the role of MCs in UVR-driven skin diseases and the influence of UV light on MC-mediated skin diseases. This summary of our current understanding of the interplay of skin MCs and UVR may help to improve the management of patients with urticaria and other MC disorders, to identify current gaps of knowledge, and to guide further research.

This article is protected by copyright. All rights reserved.

http://ift.tt/2unFZb1

Erratum to “Changing prevalence and treatment outcomes of patients with p16 human papillomavirus related oropharyngeal squamous cell carcinoma in New Zealand” [Br. J. Oral Maxillofac. Surg. 54 (8) (2016) 898–903]

Publication date: Available online 4 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H.J. Kwon, H.D. Brasch, S. Benison, R.W. Marsh, T. Itinteang, G.W. Titchener, J. Evans, S.T. Tan




http://ift.tt/2tH6ivi

Advances towards fully automated in vivo assessment of oral epithelial dysplasia by nuclear endomicroscopy – A pilot study

Abstract

Background

uncertainties in detection of oral epithelial dysplasia (OED) frequently result from sampling error especially in inflammatory oral lesions. Endomicroscopy allows non-invasive, "en face" imaging of upper oral epithelium but parameters of OED are unknown.

Methods

mucosal nuclei were imaged in 34 toluidine blue stained oral lesions with a commercial endomicroscope. Histopathological diagnosis showed 4 biopsies in "dys-/ neoplastic", 23 in "inflammatory", 7 in "others" disease groups. Strength of different assessment strategies of nuclear scoring, nuclear count and automated nuclear analysis were measured by area under ROC–curve (AUC) to identify histopathological "dys-/neoplastic" group. Nuclear objects from automated image analysis were visually corrected.

Results

best performing parameters of nuclear-to-image ratios were the count of large nuclei (AUC=.986) and 6-nearest-neighborhood relation (AUC=.896) and for parameters of nuclear polymorphism the count of atypical nuclei (AUC=.996) and compactness of nuclei (AUC=.922). Excluding low grade OED nuclear scoring and count reached 100% sensitivity and 98% specificity for detection of dys-/neoplastic lesions. In automated analysis, combination of parameters enhanced diagnostic strength. Sensitivity of 100% and specificity of 87% was seen for distances of 6-nearest-neighbors and aspect ratios even in uncorrected objects. Correction improved measures of nuclear polymorphism only. The hue of background color was stronger than nuclear density (AUC=.779 vs. .687) to detect dys-/neoplastic group indicating that macroscopic aspect is biased.

Conclusions

nuclear-to-image ratios are applicable for automated optical in vivo diagnostics for oral potentially malignant disorders. Nuclear endomicroscopy may promote non-invasive, early detection of dys-/neoplastic lesions by reducing sampling error.

This article is protected by copyright. All rights reserved.

http://ift.tt/2uIkjWi

A Rare Case of Primary Bilateral Adrenal Lymphoma

Lymphoma may involve the adrenal glands, but primary lymphoma is rare. Only a few cases have been reported in medical literature. Primary adrenal lymphoma is extremely rare, accounting for

http://ift.tt/2tK9eXP

Stability of biodegradable metal (Mg-Ca-Zn alloy) screws compared with absorbable polymer and titanium screws for sagittal split ramus osteotomy of the mandible using the finite element analysis model

Mg-Ca-Zn alloy has been suggested for the application of fixation materials during maxillofacial surgery. We investigated the stability of Mg-Ca-Zn alloy for clinical application during orthognathic surgery. The finite element model for the fixation of sagittal split ramus osteotomy was constructed. In the bicortical screw fixation of the mandible setback condition, the stress distributions of Mg-Ca-Za alloy, polylactic acid polymer, and titanium were evaluated using the virtual model with occlusal loading of 132 N.

http://ift.tt/2sDuIGy

Automatic repositioning of jaw segments for three-dimensional virtual treatment planning of orthognathic surgery

To develop a computer-based method for automating the repositioning of jaw segments in the skull during three-dimensional virtual treatment planning of orthognathic surgery. The method speeds up the planning phase of the orthognatic procedure, releasing surgeons from laborious and time-consuming tasks.

http://ift.tt/2tnDJAu

Three-Dimensional analysis of the pharyngeal airway space and hyoid bone position after orthognathic surgery

The aim of this study was to evaluate changes in the pharyngeal airway space (PAS) and hyoid bone position after orthognathic surgery with cone-beam computed tomography (CBCT).

http://ift.tt/2sDRDBC

Clinicopathological features, management and outcome of patients with poorly-differentiated oral and oropharyngeal squamous cell carcinoma

The purpose of this study was to explore the clinicopathological features, risk factors, and management of poorly differentiated oral and oropharyngeal squamous cell carcinoma (OOSCC) patients in the northern Chinese population.

http://ift.tt/2tnLy9o

Electromyographic analysis of superior orbicularis oris muscle function in children surgically treated for unilateral complete cleft lip and palate

The aim of this study was to assess the electrical activity of the superior orbicularis oris muscle in children surgically treated for unilateral complete cleft lip and palate (UCCLP).

http://ift.tt/2tnpVpA

Erratum to “Changing prevalence and treatment outcomes of patients with p16 human papillomavirus related oropharyngeal squamous cell carcinoma in New Zealand” [Br. J. Oral Maxillofac. Surg. 54 (8) (2016) 898–903]

The publisher regrets that the below figure (Fig. 3) was omitted from the above mentioned paper and apologises for the error.

http://ift.tt/2sDmX3i

Age-related changes in the morphological relationship between the supratubal recess and the Eustachian tube

To study age-related changes in the morphology of the supratubal recess (STR) and its relationship with the Eustachian tube (ET).

http://ift.tt/2snzFPu

Age-related changes in the morphological relationship between the supratubal recess and the Eustachian tube

Publication date: Available online 4 July 2017
Source:Auris Nasus Larynx
Author(s): Juan Hong, Keguang Chen, Huiying Lyu, Dongming Yin, Lin Yang, Tianyu Zhang, Peidong Dai
ObjectiveTo study age-related changes in the morphology of the supratubal recess (STR) and its relationship with the Eustachian tube (ET).MethodsSeventy randomly selected computed tomography (CT) images of non-pathological temporal bones of 49 patients were reviewed retrospectively. The patients were grouped according to age into 4 age groups: group A (0–3 years), group B (4–8 years), group C (9–18 years) and group D (19–50 years). Space analytic geometry was assessed to directly calculate the morphology of the STR and the ET.ResultsIn normal temporal bones, the STR was mostly presented with a solitary cell in life. The length of the STR was significantly longer in group C than that in group A (P<0.05). The width of the STR was declined with age and presented with significant difference among age groups (P<0.05). No significant difference was observed in the height of the STR in whole age groups (P>0.05). The aeration of the STR was intimately related with age-related morphological changes in the ET. But the important factors influencing the aeration of the STR were not always the same in different age stages.ConclusionThe extended length and declined width of the STR with age were mostly related with the prolonging bony part and inwardly bending cartilaginous part of the ET in children and adolescent aged from 0 to 18 years old. In adults aged more than 18 years old, the narrowed caliber of the tympanic orifice of the ET could induce the decline in the width of the STR with age, but unfolded horizontal cartilaginous part of the ET contributed to stable length and height in aeration of the STR.



http://ift.tt/2sK0fSk

Secondary encephalocele in infant following subdural empyema repaired endoscopically-A case report

Publication date: Available online 4 July 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Roshan K. Verma, Navjot Kaur
Subdural empyema (SDE) is an uncommon entity, mostly associated with meningitis and can be life threatening in infants. Rarely, a subdural empyema can lead to nasal encephalocele which can be challenging situation to manage especially in infant. We present a case of 7 month old infant who presented with subdural empyema that led to formation of nasal encaphalocele after 4 months which was managed endoscopic route.



http://ift.tt/2uHTnpP

The effect of pneumococcal conjugate vaccines on incidence and microbiology associated with complicated acute otitis media

Publication date: Available online 4 July 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): B.B. Laursen, C.S. Danstrup, S. Hoffmann, N. Nørskov-Lauritsen, A.L.B. Christensen, T. Ovesen
ObjectivesThe objectives of this study were to investigate the incidence of complicated acute otitis media (cAOM) as well as the associated microbiology before and after introduction of the 7- and 13-valent pneumococcal conjugate vaccines (PCV-7 and -13), respectively. CAOM comprises "heavy" AOM (AOM demanding hospitalization), mastodismus (M) and acute mastoiditis (AM).MethodsA retrospective cohort study of the incidence and microbiology associated with cAOM during the non-PCV era, the PCV-7 and 13 eras, respectively. Clinical and microbiological data were prospectively registered in a local database. The incidences of cAOM as well as the distribution of various bacterial strains in the three eras were compared.ResultsA total of 246 cases of cAOM (125 in the pre-vaccine period (2001-2006), 50 in the PCV-7 period (2007-2010) and 71 in the PCV-13 period (2011-2015)) were identified.The incidence of hAOM decreased by 62% in the PCV7-era but increased to almost pre-vaccine levels in the PCV-13 era. In the M + AM group, a decrease by almost 21 % in the PCV7-era was found compared to the pre vaccine era, whereas the decrease was only 12 % in the PCV13-era.The three most common findings in both hAOM and M + AM were Streptococcus pneumonia (SP), group A streptococcus (GAS) and "no growth". In the hAOM group, SP decreased from 38% in the pre-vaccine era to 31% in the PCV7-era and further to 16% in the PCV13-era. GAS decreased from 17% in the pre-vaccine era to 0% in the PCV7-era and 16% in the PCV13-era. The percentage of "no growth" increased from 12 % to 38 % and 44 %, respectively.In the M + AM group, SP decreased to 10 % in the PCV13-era compared with 44 % in the pre-vaccine era and 41 % in the PCV7-era. An increase in GAS from 15 % in the pre-vaccine era and PCV7-era to 30 % in the PCV13-era was observed. The "no growth" percentage increased from 13 % in the pre-vaccine era to 26% in the PCV7-era and 33% in the PCV13-era.ConclusionIntroduction of PCV7 and PCV13 has been associated with an overall reduction of cAOM in Central Region Denmark. Pneumococci were still one of the two most common bacteria species related to cAOM though a decrease in pneumococci positive cases was observed. We found an increase in M + AM induced by GAS and a relatively large increase in "no growth", which might be caused by a more aggressive pre-hospital approach to treatment with antibiotics. Consequently, it is not evident whether the reduction of incidences is caused by the vaccines or a more aggressive antimicrobial attitude to manage AOM. The shift to GAS from SP is worrisome, and therefore continuous surveillance of the microbiology associated with AOM is warranted.



http://ift.tt/2tJOteA

Changes in pediatric tracheostomy tubes exposed to home dishwashing

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): David E. Smolar, Brian Ho, Steven M. Kent, C. Anthony Hughes, Donald Mettenburg, Fredrick A. Rueggeberg, Michael W. Groves
ObjectiveDetermine the effects of household dishwashing on Tracheostomy Tube safety.IntroductionTracheostomy tubes accumulate biofilms, which may limit their lifespan. Frequent cleaning of the tubes is a method for biofilm prevention. Cleaning practices vary widely. Some families prefer dishwashing of tubes, but its effects are currently unknown. We hypothesize that dishwashing has no significant effect on the physical properties of tracheostomy tubes and can be recommended as a safe way to clean tracheostomy tubes.MethodsTwenty 4.0 Shiley™ pediatric tracheostomy tubes were randomly assigned into dishwashed (DW) and non-dishwashed (NDW) groups, 10/group. DW tubes were subjected to 12 wash cycles. Each tube's hardness along with the surface spectra were analyzed to assess for chemical composition changes. Three cannula samples from each group were also randomly assessed with scanning-electron microscopy and scored by blinded examiners to assess for changes in surface heterogeneity.ResultsHardness testing revealed a statistically significant difference (p = 0.0009) between the NDW and the DW group indicating increased fragility in the dishwashed tubes. Spectral analysis revealed loss of plasticizers, indicating decreased flexibility. Blinded electron microscopy scoring revealed increased surface heterogeneity in the DW group (p = 0.00007).ConclusionA significant decrease in tube hardness and increased surface heterogeneity were found with dishwashing. The spectral analysis demonstrated increasing fragility. We believe these effects could potentially lead to decreased mechanical safety. With increased surface heterogeneity there is a greater potential for biofilm formation. At this time, dishwashing cannot be recommended as a tracheostomy tube cleaning method.



http://ift.tt/2uHUp54

Assessment of weight gain following adenotonsillectomy in children with Down syndrome

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Christopher F. D'Esposito, Zachary Farhood, Andrew B. Baker, Shaun A. Nguyen, Angela C. LaRosa, Chitra Lal, David R. White
IntroductionAdenotonsillectomy (T&A) has been associated with postoperative weight gain in children. The purpose of this study is to determine whether a similar association exists in children with Down syndrome (DS).MethodsThe medical records of 311 DS patients were reviewed. Subjects were classified into either a control group or surgical group based on whether they had undergone adenotonsillectomy (T&A). Subjects were excluded if they only had one recorded BMI. Cases were analyzed in a pairwise fashion to maximize available data. 113 total patients with DS were identified: 84 (74.3%) in the control group and 29 (25.7%) in the T&A group. Height, weight, BMI, and Z-score data were compared between the control and T&A groups at 6-month intervals over a 24-month period.ResultsChildren with DS who underwent T&A were comparable by demographics to children with DS who did not undergo T&A. Mean weight gain at 24 months for the T&A group was 8.07 ± 5.66 kg compared with 5.76 ± 13.20 kg in controls. The median Z-score at 24 months for the T&A group was 1.11 (0.10–1.88) compared with 1.17 (0.80–1.75) in controls. Children undergoing T&A had a stable median Z-score change of 0.09 at 24 months (p = 0.861, compared to baseline) while children who did not undergo T&A had a significantly increased median Z-score of 0.52 (p = 0.035, compared to baseline). Despite this, there were no significant intergroup differences between weight change, BMI, nor Z-score at any interval (p > 0.05).Conclusions and relevanceChildren with DS did not have an increased rate of weight gain or increased BMI after T&A. BMI Z-scores were shown to stabilize over 24 months in the T&A group and increase in the control group. While this suggests that T&A provides an added benefit of weight control in patients with DS, the results should be interpreted with caution due to the small sample size and the fact that not all patients had complete follow up across a 24-month period.



http://ift.tt/2tJTbch

Evaluation of ototoxicity of intratympanic administration of Methotrexate in rats

Publication date: Available online 4 July 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Sabri Baki Eren, Remzi Dogan, Alper Yenigun, Bayram Veyseller, Selahattin Tugrul, Orhan Ozturan, Mehmet Serif Aydin
ObjectiveMethotrexate is a dihydrofolate reductase enzyme inhibitor with very high selectivity, and it is an antiproliferative folic acid antagonist used for the treatment of autoimmune diseases. In this study, our objective was to evaluate the effect of intratympanic Methotrexate application in the inner ear.MethodsThis study was planned as an animal study. This study performed in a tertiary referral center. 24 healthy female rats were used in our study. They were separated into three groups. 0.2 cc intratympanic saline was applied to both ears of Group 1. Paracentesis was applied to the tympanic membrane in both ears of Group 2. 0.2 cc intratympanic Methotrexate was applied to both ears of Group 3. At the beginning of the study, Distortion-product otoacoustic emissions (DPOAE) and Auditory brainstem response (ABR) of all rats were measured and then again on the 5th, 10th and 15th day. Histologic examinations of all groups were compared.ResultsThere was not any significant difference between basal DPOAE and ABR measurement values of the groups and the results were measured again on the 5th, 10th and 15th day (p>0.05). There was no difference between the groups in terms of histology.ConclusionThe intratympanic Methotrexate injection does not have any ototoxic effect on inner ear. We assume that intratympanic Methotrexate could be used safely on inner ear diseases in which steroid treatment is contraindicated or not effective.



http://ift.tt/2tJVH2a

In response to the letter to the editor regarding: Rat model of chronic tympanic membrane perforation: Ventilation tube with mitomycin C and dexamethasone

Publication date: Available online 4 July 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Allen Y. Wang, Lawrence J. Liew, Yi Shen, Jeffrey T. Wang, Magnus von Unge, Rodney J. Dilley




http://ift.tt/2uHJb0p

Letter to the Editor regarding: Rat model of chronic tympanic membrane perforation: Ventilation tube with mitomycin C and dexamethasone

Publication date: Available online 4 July 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Zheng-Cai Lou




http://ift.tt/2tJJrik

How do geometry-related parameters influence the clinical performance of orthodontic mini-implants? A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to investigate how parameters related to geometry influence the clinical performance of orthodontic mini-implants (MIs). Systematic searches were performed in electronic databases including MEDLINE, Scopus, Web of Science, Virtual Health Library, and Cochrane Library and reference lists up to March 2016. Eligibility criteria comprised clinical studies involving patients who received MIs for orthodontic anchorage, with data for categories of MI dimension, shape, and thread design and insertion site, and evaluated by assessment of primary and secondary stability.

http://ift.tt/2sJTX59

Anaesthesia for laryngo-tracheal surgery, including tubeless field techniques

1C012A013A02

http://ift.tt/2sD68oV

Regional anaesthesia for ophthalmic surgery

1A011A022G012G023A093A12

http://ift.tt/2tn0ggV

Diagnosis and management of malignant hyperthermia

1A012A063I00

http://ift.tt/2sDmeiy

Critical care management of pulmonary hypertension

Abstract

Patients with pulmonary hypertension (PH) can be extremely challenging to manage in the critical care setting. In this article we review the classification, diagnosis, and chronic management of PH. An approach to the management of the critically unwell PH patient is discussed. Initial management involves treating underlying precipitants of deterioration and optimizing right ventricular (RV) preload. Reduction of RV afterload with pulmonary vasodilators is also required. Augmentation of cardiac function and perfusion pressures with inotropes and vasopressors may additionally be needed. Advanced renal and respiratory support may be appropriate depending on the clinical context. Patients with known PH who have undergone major surgery or who are in the immediate postpartum period are also at significant risk of deterioration and require management in the critical care setting. Although pulmonary vasodilators are associated with improvements in pulmonary haemodynamics and oxygenation in patients with acute respiratory distress syndrome or after cardiac surgery, there is currently no evidence demonstrating improved outcomes.

http://ift.tt/2tmUvQa

Postoperative management of the difficult airway

1C012A013A01

http://ift.tt/2sDkGow

Mepolizumab Efficacy in Patients with Severe Eosinophilic Asthma Receiving Different Controller Therapies

Publication date: Available online 4 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Frank C. Albers, Robert G. Price, Steven G. Smith, Steven W. Yancey

Teaser

This post hoc analysis of the MENSA study demonstrates that mepolizumab reduced the annualized exacerbation rate relative to placebo in patients with severe eosinophilic asthma irrespective of the number or type of background controller therapies.


http://ift.tt/2snaNHK

Reduced need for surgery in severe nasal polyposis with mepolizumab: randomised trial

Publication date: Available online 4 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Claus Bachert, Ana R. Sousa, Valerie J. Lund, Glenis K. Scadding, Philippe Gevaert, Shuaib Nasser, Stephen R. Durham, Marjolein E. Cornet, Harsha H. Kariyawasam, Jane Gilbert, Daren Austin, Aoife C. Maxwell, Richard P. Marshall, Wytske J. Fokkens
BackgroundPatients with eosinophilic nasal polyposis frequently require surgery, and recurrence rates are high.ObjectiveTo assess the efficacy and safety of mepolizumab vs placebo for severe bilateral nasal polyposis.MethodsThis randomised, double-blind, placebo-controlled trial recruited patients aged 18−70 years with recurrent nasal polyposis requiring surgery. Patients received intravenous mepolizumab 750 mg or placebo every 4 weeks for a total of six doses, in addition to daily topical corticosteroid treatment. The primary endpoint was the number of patients no longer requiring surgery at Week 25, based on a composite endpoint of endoscopic nasal polyp score and nasal polyposis severity visual analogue scale (VAS) score. Secondary endpoints included change in nasal polyposis severity VAS score, endoscopic nasal polyp score, improvement in individual VAS symptoms (rhinorrhoea, mucus in throat, nasal blockage, and sense of smell), patient-reported outcomes (PRO), and safety.Results105 patients received mepolizumab (n=54) or placebo (n=51). A significantly greater proportion of patients in the mepolizumab group compared with the placebo group no longer required surgery at Week 25 (16[30%] vs 5[10%], respectively; P=0.006). There was a significant improvement in nasal polyposis severity VAS score, endoscopic nasal polyp score, all individual VAS symptom scores, and sino-nasal outcome test [SNOT]-22 PRO score in the mepolizumab group compared with placebo. Mepolizumab's safety profile was comparable to placebo.ConclusionIn patients with recurrent nasal polyposis on topical corticosteroids who required surgery, mepolizumab treatment led to a greater reduction in the need for surgery and a greater improvement in symptoms than placebo.Clinical implicationsResults suggest that mepolizumab treatment has the potential to improve quality of life and reduce surgery-associated burden for patients with severe nasal polyposis.

Teaser

This was the first study to show that mepolizumab treatment added to daily nasal corticosteroids offers a viable alternative to surgery in patients with severe, recurrent nasal polyposis requiring surgery.


http://ift.tt/2tGmIny

Reviewing the impact of lipid synthetic flux on Th17 function

Yoko Kidani | Steven J Bensinger

http://ift.tt/2uElRAZ

Surgical Treatment of Retrosternal Goitre

Abstract

This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age 67.4 ± 10.9 years) with retrosternal goitre (mainly right-sided in 9, left-sided in 14 and bilateral in 12) underwent surgery. A palpable neck mass was found in 11 (31.4%), stridor in 10 (28.6%) and thyrotoxicosis in 4 (11.4%) cases. 4 (11.4%) patients were asymptomatic. Tracheal compression was detected radiologically in 27 (77.2%) patients with deviation in 18 (51.4%). A collar incision was performed in 34 patients, 6 (17.1%) of whom required additional sternotomy, 1 (2.9%) was assisted by an anterior mediastinotomy. 1 (2.9%) had a right lateral thoracotomy. There was no operative mortality. Transient vocal changes occurred in 3 (8.6%) patients, recurrent laryngeal nerve palsy in 3, atrial fibrillation in 2, and wound complications in 2 (5.7%). Hospital stay ranged from 2 to 12 days (5.5 ± 2.0). Multinodular goitre was found in 33 patients, diffuse goitre in 1 and ectopic thyroid in 1. The average vertical length of goitres in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. The average weight of specimens was 156.3 g in patients with collar incisions and 307.5 g in the sternotomy group. Removal of retrosternal goitre is more commonly performed via a cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the risk of sternotomy. Surgical outcomes are not affected by surgical approach.

http://ift.tt/2uGZivj

Vitamin D supplementation in primary allergy prevention: systematic review of randomized and non-randomized studies

Abstract

Background

To date, a systematic review of the evidence regarding the association between Vitamin D and allergic diseases development has not yet been undertaken.

Objective

To review the efficacy and safety of Vitamin D supplementation when compared to no supplementation in pregnant women, breastfeeding women, infants and children for the prevention of allergies.

Methods

Three databases were searched through 30 January 2016 including randomized (RCT) and non-randomized studies (NRS). Two reviewers independently extracted data and assessed the certainty in the body of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results

Among the 1932 articles identified, one RCT and four NRS were eligible. Very low certainty in the body of evidence across examined studies suggests that Vitamin D supplementation for pregnant women, breastfeeding women and infants may not decrease the risk of developing allergic diseases such as atopic dermatitis (in pregnant women), allergic rhinitis (in pregnant women, and infants), asthma and/or wheezing (in pregnant women, breastfeeding women, and infants), or food allergies (in pregnant women). We found no studies of primary prevention of allergic diseases in children.

Conclusion

Limited information is available addressing primary prevention of allergic diseases after Vitamin D supplementation and its potential impact remains uncertain.

This article is protected by copyright. All rights reserved.

http://ift.tt/2umZMrk

Estimating the causal effect of body mass index on hay fever, asthma, and lung function using Mendelian randomization

Abstract

Background

Observational studies have shown that body mass index (BMI) is positively associated with asthma. However, observational data are prone to confounding and reverse causation. In Mendelian randomization, genetic variants are used as un-confounded markers of exposures to examine causal effects. We examined the causal effect of BMI on asthma, hay fever, allergic sensitization, serum total immunoglobulin E (IgE), forced expiratory volume in one second (FEV1), and forced vital capacity (FVC).

Methods

We included 490,497 participants in the observational and 162,124 participants in the genetic analyses. A genetic risk score (GRS) was created using 26 BMI-associated single nucleotide polymorphisms (SNPs). Results were pooled in meta-analyses and expressed as odds ratios (ORs) or β-estimates with 95% confidence interval (CI).

Results

The GRS was significantly associated with asthma (OR=1.009; 95% CI: 1.004, 1.013), but not with hay fever (OR= 0.998; 95% CI: 0.994, 1.002), or allergic sensitization (OR=0.999; 95% CI: 0.986, 1.012) per BMI-increasing allele. The GRS was significantly associated with decrease in FEV1: β=-0.0012 (95% CI: -0.0019, -0.0006) and FVC: β=-0.0022 (95% CI: -0.0031, -0.0014) per BMI-increasing allele. Effect sizes estimated by instrumental variable analyses were OR=1.07 (95% CI: 1.03, 1.10) for asthma, a 9 ml decrease in FEV1 (95% CI: 2.0-15 ml decrease), and a 16 ml decrease in FVC (95% CI: 7.0-24 ml decrease) per 1 kg/m² higher BMI.

Conclusions

The results support the conclusion that increasing BMI is causally related to higher prevalence of asthma and decreased lung function, but not with hay fever or biomarkers of allergy.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tNX7d5

Finding an upper limit of what might be achievable by patients: oral cleanliness in dental professionals after self-performed manual oral hygiene

Abstract

Aims

Though patients have been shown to have difficulties in achieving oral cleanliness after self-performed oral hygiene, scientifically and empirically justified standards for the degree of oral cleanliness they should achieve are lacking. Oral cleanliness of dental staff was therefore assessed as an indicator of what might be an upper limit of what can be expected by patients.

Materials and methods

In a multicentre study, N = 64 university dentists, N = 33 dental students and N = 30 dental assistants were asked to perform manual oral hygiene to the best of their abilities. The presence or absence of dental plaque adjacent to gingival margins was assessed by the marginal plaque index (MPI). As full-crown index, the Turesky modification of the Quigley and Hein Index (QHIm) was applied.

Results

Only three participants showed papillary bleeding and only one a clinical pocket depth of more than 3.5 mm. After self-performed oral hygiene, no differences between groups were observed with respect to plaque nor did results differ between those who habitually used a powered toothbrush only and those who did not. Most participants (96%) achieved oral cleanliness at more than 70% of their gingival margins and QHIm levels below .63. Half of the participants showed QHIm levels below .17 and oral cleanliness at 96% of gingival margins.

Conclusions and clinical relevance

Considering that half of the dental professionals achieved oral cleanliness at 96% of gingival margins and QHIm levels below .17 after thorough oral hygiene, this might reflect an upper limit of what can be expected by patients.

http://ift.tt/2tNHXEq

Estimated prevalence of halitosis: a systematic review and meta-regression analysis

Abstract

Objective

This study aims to conduct a systematic review to determine the prevalence of halitosis in adolescents and adults.

Methods

Electronic searches were performed using four different databases without restrictions: PubMed, Scopus, Web of Science, and SciELO. Population-based observational studies that provided data about the prevalence of halitosis in adolescents and adults were included. Additionally, meta-analyses, meta-regression, and sensitivity analyses were conducted to synthesize the evidence.

Results

A total of 584 articles were initially found and considered for title and abstract evaluation. Thirteen articles met inclusion criteria. The combined prevalence of halitosis was found to be 31.8% (95% CI 24.6–39.0%). Methodological aspects such as the year of publication and the socioeconomic status of the country where the study was conducted seemed to influence the prevalence of halitosis.

Conclusions

Our results demonstrated that the estimated prevalence of halitosis was 31.8%, with high heterogeneity between studies. The results suggest a worldwide trend towards a rise in halitosis prevalence.

Clinical relevance

Given the high prevalence of halitosis and its complex etiology, dental professionals should be aware of their roles in halitosis prevention and treatment.

http://ift.tt/2umtpsM

Oral Complications at Six Months after Radiation Therapy for Head and Neck Cancer

Abstract

Objective

Examine oral complications 6 months after modern radiation therapy (RT) for head and neck cancer (HNC).

Methods

Prospective multi-center cohort study of HNC patients receiving Intensity-Modulated Radiation Therapy (IMRT) or more advanced RT. Stimulated whole salivary flow, maximal mouth opening, oral mucositis, oral pain, oral health-related quality of life (OH-QOL), and oral hygiene practices, were measured in 372 subjects pre-RT and 216 at 6 months from start of RT.

Results

Mean stimulated whole salivary flow declined from 1.09 ml/min to 0.47 ml/min at 6 months (p < 0.0001). Mean maximal mouth opening reduced from 45.58 mm to 42.53 mm at 6 months (p < 0.0001). 8.1% of subjects had some oral mucositis at 6 months, including 3.8% with oral ulceration. Mean overall pain score was unchanged. OH-QOL was reduced at 6 months, with changes related to dry mouth, sticky saliva, swallowing solid foods, and sense of taste (p ≤ 0.0001). At 6 months, there was greater frequency of using dental floss and greater proportion using supplemental fluoride (p < 0.0001).

Conclusions

Despite advances in RT techniques, HNC patients experience oral complications 6 months after RT, with resulting negative impacts on oral function and quality of life.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tmplIB

Achieved chin position after genioplasty follows the planned horizontal change better than the planned vertical change

Publication date: Available online 6 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Jimoh Olubanwo Agbaje, Yi Sun, Ahmed S. Salem, Zhaokai Li, Kelvin Osei Adu, Constantinus Politis
PurposeThe soft-tissue pogonion closely follows changes of the bony pogonion, but it is unknown how often an augmented bony pogonion reaches the intended position. Here we assessed the agreement between planned surgical changes and achieved results in chin surgery.Materials and methodsSurgical treatment was planned based on clinical examination, cast model analysis, and cephalometric image analysis. The mobile chin segment was stabilized using one chin plate. Preoperative and postoperative cephalometric X-ray images were digitized, and cephalometric tracing was performed. We calculated and analyzed the changes between the preoperative and postoperative images as well as between planned genioplasty movements and actual surgical changes in the horizontal and vertical directions.ResultsThis study included 36 patients. In 34 patients, the absolute mean horizontal difference was less than 2 mm. We found a higher range of absolute error in vertical (0.00–5.60) compared to horizontal (0.01–3.64) movement. There was no significant difference between the mean planned chin movement and the mean achieved position with regard to the horizontal and vertical movement (p = 0.97 and 0.79, respectively).ConclusionsThe mean values for linear difference in both the horizontal and vertical directions were in line with the acceptable mean of ≤2 mm proposed in the literature.



http://ift.tt/2tFSgtP

Surgical Treatment of Retrosternal Goitre

Abstract

This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age 67.4 ± 10.9 years) with retrosternal goitre (mainly right-sided in 9, left-sided in 14 and bilateral in 12) underwent surgery. A palpable neck mass was found in 11 (31.4%), stridor in 10 (28.6%) and thyrotoxicosis in 4 (11.4%) cases. 4 (11.4%) patients were asymptomatic. Tracheal compression was detected radiologically in 27 (77.2%) patients with deviation in 18 (51.4%). A collar incision was performed in 34 patients, 6 (17.1%) of whom required additional sternotomy, 1 (2.9%) was assisted by an anterior mediastinotomy. 1 (2.9%) had a right lateral thoracotomy. There was no operative mortality. Transient vocal changes occurred in 3 (8.6%) patients, recurrent laryngeal nerve palsy in 3, atrial fibrillation in 2, and wound complications in 2 (5.7%). Hospital stay ranged from 2 to 12 days (5.5 ± 2.0). Multinodular goitre was found in 33 patients, diffuse goitre in 1 and ectopic thyroid in 1. The average vertical length of goitres in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. The average weight of specimens was 156.3 g in patients with collar incisions and 307.5 g in the sternotomy group. Removal of retrosternal goitre is more commonly performed via a cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the risk of sternotomy. Surgical outcomes are not affected by surgical approach.

http://ift.tt/2uGZivj

A Double-Blind, Randomised Study Comparing the Skin Hydration and Acceptability of Two Emollient Products in Atopic Eczema Patients with Dry Skin

Abstract

Introduction

Healthcare professionals tend to recommend emollients based primarily on patient/consumer preference and cost, with cheaper options assumed to be therapeutically equivalent. The aim of this study was therefore to compare the effects on skin hydration of two emollients prescribed in the UK, Doublebase Dayleve™ gel (DELP) and a cheaper alternative, Zerobase Emollient™ cream (ZBC).

Methods

This was a single-centre, randomised, double-blind, concurrent bi-lateral (within-patient) comparison in 18 females with atopic eczema and dry skin on their lower legs. DELP gel and ZBC cream were each applied to one lower leg twice daily for 4 days and on the morning only on day 5. The efficacy of both products was assessed by hydration measurements using a Corneometer CM825 probe (Courage-Khazaka Electronic). The measurements were made three times daily on days 1 to 5. The primary efficacy variable was the area under the curve (AUC) of the change from baseline corneometer readings over the 5 days.

Results

Skin hydration using DELP gel was significantly higher than using ZBC cream (p < 0.0001). The cumulative increase in skin hydration observed for DELP gel was substantial and long lasting. In contrast, for ZBC cream, there was no significant improvement of the cumulative skin hydration as measured by the AUC (p = 0.22).

Conclusion

DELP gel achieved substantial, long-lasting and cumulative skin hydration, whilst ZBC cream achieved no measurable improvement in skin hydration compared to before treatment. Healthcare professionals should be aware that different emollients can perform differently.

Funding

Dermal Laboratories Ltd.

Trial Registration

EudraCT number:2014-001026-16.

http://ift.tt/2tEVxda

Specific immunotherapy in allergic rhinitis

Publication date: Available online 3 July 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): G. Mortuaire, J. Michel, J.F. Papon, O. Malard, D. Ebbo, L. Crampette, R. Jankowski, A. Coste, E. Serrano
Allergic rhinitis is a common condition, with significant impact on quality of life depending on severity and quality of control. Allergen-specific immunotherapy (allergen-SIT) is the only known treatment able to alter the natural course of allergic rhinitis. Although well known to allergologists, it has yet to be fully adopted by the ENT community. This review, based on the most recent meta-analyses and clinical studies, shows that SIT significantly reduces symptoms and medication requirements (nasal corticosteroids, H1-antihistamines) in allergic rhinitis. It can reduce the risk of progression to asthma and, if initiated early enough, of developing new sensitizations. Immunobiological analysis shows an altered inflammatory profile following SIT, with immune tolerance involving T-regulatory lymphocyte induction and IgG production. Sublingual SIT with drops is as effective as subcutaneous SIT and is simpler to use, with less anaphylactic risk. Standardization of trial protocols in terms of treatment response assessment and side effect grading is recommended to improve comparative studies. Sublingual SIT with tablets has recently been introduced, providing a good opportunity for ENT practitioners to adopt the SIT approach in rhinitis triggered by allergy to pollens and, in the near future, to house dust mites.



http://ift.tt/2tFEJTn

Rare presentation of intractable tuberculous panophthalmitis with intraocular and intraorbital abscesses: a case report

We report a rare presentation of extrapulmonary tuberculosis.

http://ift.tt/2tmaJt5

Anthropometric study of the Caucasian nose in the city of Curitiba: relevance of population evaluation

Publication date: Available online 3 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Annelyse Cristine Ballin, Bettina Carvalho, José Eduardo Lutaif Dolci, Renata Becker, Cezar Berger, Marcos Mocellin
IntroductionNorms and patterns of nasal esthetics are essential for an adequate preoperative evaluation and surgical programming. The esthetic nasal patterns used are a blend of artistic beauty ideals and tracings in models and celebrities. Because they do not consider population measures, they vary according to the period, and allow a discrepancy between the surgeon's preference and the patient's real desire for rhinoplasty. Not all populations wish to obtain an esthetic result according to these values, but prefer a natural result, that is, one with some of the nasal characteristics of the population to which they belong to. The Brazilian population lacks population studies to evaluate its nose measurements.Objective(1) To evaluate the anthropometric measures of Caucasian noses of people living in the city of Curitiba (state of Paraná), and to compare them to the ideal esthetic pattern of the literature; (2) To compare them between genders.MethodsThis is a prospective cohort study involving 100 Caucasian volunteers at a tertiary hospital in Southern Brazil. Through the frontal and lateral view photos, intercanthal distance, alar distance, nasal dorsum length, nasofrontal angle, nasolabial angle, and nasal tip projection (Goode's method) were obtained. A statistical analysis was performed to compare the measures obtained between genders and with the ideal patterns.ResultsComparing the results obtained with those predicted by the esthetic ideals, the sample presented: similar nasolabial angle (p=0.07), alar width greater than intercanthal distance (p<0.001), higher nasal tip projection (p<0.001), larger width–length ratio (p<0.001), and more obtuse nasofrontal angle (p<0.001). The nasofrontal angle (p=0.0008) and the tip projection (p=0.032) were statistically different between the genders. Men had a smaller nasofrontal angle, and a larger Goode's ratio.ConclusionExcept for the nasolabial angle, the measures obtained in the population sample differed from the published esthetic ideals. Comparing the genders, men had a sharper nasofrontal angle, and higher tip projection than women.



http://ift.tt/2tFcxQd

Impact of highly active antiretroviral therapy on the prevalence of oral lesions in HIV-positive patients: a systematic review and meta-analysis

Publication date: Available online 3 July 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): V.L. de Almeida, I.F.P. Lima, P.K. Ziegelmann, L.R. Paranhos, F.R. de Matos
The aim of this study was to determine whether highly active antiretroviral therapy (HAART) is associated with the prevalence of oral lesions in HIV-positive patients. This systematic review and meta-analysis was performed in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was conducted in seven electronic databases (PubMed, Scopus, SciELO, LILACS, Embase, Web of Science, and OpenGrey), without restriction on publication period or language. Studies that showed the prevalence of oral lesions manifested in adult HIV-positive patients, subjected or not to HAART, were selected. The meta-analysis estimate of relative risk was calculated using the Mantel–Haenszel method and DerSimonian and Laird estimator to determine the variance between studies in the random-effects model. The meta-analysis showed significant results in favour of the group on HAART, with lower prevalence for angular cheilitis, erythematous candidiasis, oral herpes, pseudomembranous candidiasis, Kaposi sarcoma, and oral hairy leukoplakia. The prevalence of oral mucosal hyperpigmentation was higher in patients on HAART. These results suggest that the prevalence of oral lesions in HIV-positive patients is lower for those on HAART, which might occur because of the improvement in immunity provided by the therapy.



http://ift.tt/2tHELtc

Is oestrogen associated with mandibular condylar resorption? A systematic review

Publication date: Available online 3 July 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L.F.P. Nicolielo, R. Jacobs, E. Ali Albdour, X. Hoste, J. Abeloos, C. Politis, G. Swennen
A systematic review of the literature was performed regarding the influence of oestrogen on the occurrence of mandibular condylar resorption. Search terms for oestrogen were used in combination with terms related to the effect on condylar remodelling. A search of the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases yielded 419 articles published between October 1993 and March 2017. An additional 48 articles were retrieved through manual searching of the reference lists. After initial abstract selection, 94 eligible articles were screened in detail, resulting in a final number of 33 articles included in the review. From this review, no evidence was found that oestrogen (deficiency) contributes to mandibular condylar resorption. The conclusions are limited by the lack of studies with a high level of evidence. Further investigations on serum oestrogen concentrations in women with condylar resorption are needed. Moreover, future studies should focus on the effects of the different types of medication and diseases influencing oestrogen concentrations, the utility of oestrogen concentrations during preoperative screening, and the policies for managing orthognathic surgery patients with an oestrogen deficiency. Finally, whether the mechanisms and risk factors that lead to idiopathic condylar resorption are the same in condylar resorption following orthognathic surgery remain to be elucidated.



http://ift.tt/2uFXnaw

Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement

Publication date: Available online 3 July 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.H.T. de Ruiter, R.C. Apperloo, D.M.J. Milstein, J. de Lange
Maxillomandibular advancement (MMA) is an alternative therapeutic option that is highly effective for treating obstructive sleep apnoea (OSA). MMA provides a solution for OSA patients that have difficulty accepting lifelong treatments with continuous positive airway pressure or mandibular advancement devices. The goal of this study was to investigate the different characteristics that determine OSA treatment success/failure after MMA. The apnoea–hypopnoea index (AHI) was used to determine the success or failure of OSA treatment after MMA. Sixty-two patients underwent MMA for moderate and severe OSA. A 71% success rate was observed with a mean AHI reduction of 69%. A statistically significant larger neck circumference was measured in patients with failed OSA treatments following MMA (P=0.008), and older patients had failed OSA treatments with MMA: 58 vs. 53 years respectively (P=0.037). Cephalometric analysis revealed no differences between successful and failed OSA treatment outcomes. There was no difference in maxillary and mandibular advancements between success and failed MMA-treated OSA patients. The complications most frequently reported following MMA were sensory disturbances in the inferior alveolar nerve (60%) and malocclusion (24%). The results suggest that age and neck girth may be important factors that could predict susceptibility to OSA treatment failures by MMA



http://ift.tt/2tHrUY3

Incidence, Treatment Patterns, and Health Care Costs of Infantile Hemangioma: Results of a Retrospective German Database Analysis

Abstract

Objectives

To determine the incidence, effect (defined according to treatment rate), and health care costs of infantile hemangiomas (IHs) in Germany from 2007 to 2012 by analyzing patient data of German statutory health insurances.

Methods

A retrospective analysis using data from a database matched with the overall population covered by German statutory health insurance was performed. To describe the treatment rate and costs of IHs, a search algorithm was developed dividing the study population into three groups (patients with IHs, patients with IHs possibly requiring treatment, and patients with IHs receiving treatment).

Results

The incidence of IHs was 2.0% to 3.2%, with a slight increase during the later years of the study period and a female:male ratio of 1.4:1. IH incidence was lower and girls were less likely to present with IHs than in previous reports. The mean treatment rate of IHs was 11.3%. Mean health care costs during first year of life for infants diagnosed with IHs in 2012 were slightly lower (€2,396) than for all infants (€2,649), whereas costs for infants diagnosed and treated for IHs were considerably higher (€10,550). The majority of these costs were due to hospitalization (€8,658).

Conclusion

This retrospective study is the first to analyze the incidence and sex ratio of IHs based on German claims data. The treatment rate of IHs was consistent with previous reports. The mean health care costs for treated patients with IHs were substantially higher than those for all newborns. Limitations of this study are coding bias, a limited sample size, and claims perspective (nonclinical approach).

http://ift.tt/2sI4EF8

Thymus vulgaris L. extract has antimicrobial and anti-inflammatory effects in the absence of cytotoxicity and genotoxicity

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Jonatas Rafael de Oliveira, Daiane de Jesus Viegas, Ana Paula Réquia Martins, Cláudio Antonio Talge Carvalho, Cristina Pacheco Soares, Samira Esteves Afonso Camargo, Antonio Olavo Cardoso Jorge, Luciane Dias de Oliveira
ObjectivesThis study evaluated the biological effects of the T. vulgaris L. extract., such as antimicrobial activity on planktonic cultures and mono- and polymicrobial biofilms, cytotoxicity, anti-inflammatory activity and genotoxicity.MethodsMonomicrobial biofilms of Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Streptococcus mutans and Pseudomonas aeruginosa and polymicrobial biofilms composed by C. albicans with each bacterium were formed for 48h and exposed for 5min to the plant extract. Murine macrophages (RAW 264.7), human gingival fibroblasts (FMM-1), human breast carcinoma cells (MCF-7) and cervical carcinoma cells (HeLa) were also exposed to the plant extract for 5min and the cell viability were analyzed by MTT, neutral red (NR) and crystal violet (CV) assays. Interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) produced by RAW 264.7 was quantified by ELISA, after 24h exposure to the plant extract, both in the absence and presence of lipopolysaccharide (LPS) from Escherichia coli. Genotoxicity of the plant extract was evaluated by micronucleus formation (MN) in 1000 cells. The results were analyzed by T-Test or ANOVA and Tukey's Test (P≤0.05).ResultsAll biofilms showed significant reductions in CFU/mL (colony-forming units per milliliter). Cell viability was above 50% for all cell lines. Anti-inflammatory effect on the synthesis of IL-1β and TNF-α was observed. The MN was similar or lower than the control group in all cells.ConclusionsT. vulgaris L. extract was effective against all biofilms, promoted high cell viability, anti-inflammatory effect and presented no genotoxicity.



http://ift.tt/2slX97E

Different expression patterns of Lin28 and Lin28b in mouse molar development

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Ning Dong, Yan Liu, Tiantian Zhang, Lin Zhao, Jiangang Tian, Jianping Ruan
ObjectiveThe RNA-binding proteins Lin28 and Lin28b are expressed in many developing tissues and are involved in the biosynthesis of the microRNA let-7 family and embryogenesis processes. However, their roles in mammalian tooth development remain ill-defined.DesignThe spatiotemporal expressions of Lin28 and Lin28b during mouse molar odontogenesis from day E11.5 to P21 were examined through immunohistochemistry and western blot analysis.ResultsBoth Lin28 and Lin28b were initially expressed in dental epithelium, but the expression patterns varied thereafter. Lin28 was expressed in tooth germ from early embryonic stages and was consistently expressed in the ameloblasts and odontoblasts throughout all stages of tooth development. However, positive staining of Lin28b gradually faded out with tooth germ development, before finally disappearing in tooth organ cells after birth.ConclusionsThese results indicate that Lin28 was spatiotemporally expressed in tooth germ throughout tooth development progression and may play an active role in ameloblast and odontoblast differentiation, as well as matrix secretion and the mineralization of enamel and dentin. Its paralogue Lin28b may have a distinct function in tooth germ formation.



http://ift.tt/2tEY72R

Thymus vulgaris L. extract has antimicrobial and anti-inflammatory effects in the absence of cytotoxicity and genotoxicity

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Jonatas Rafael de Oliveira, Daiane de Jesus Viegas, Ana Paula Réquia Martins, Cláudio Antonio Talge Carvalho, Cristina Pacheco Soares, Samira Esteves Afonso Camargo, Antonio Olavo Cardoso Jorge, Luciane Dias de Oliveira
ObjectivesThis study evaluated the biological effects of the T. vulgaris L. extract., such as antimicrobial activity on planktonic cultures and mono- and polymicrobial biofilms, cytotoxicity, anti-inflammatory activity and genotoxicity.MethodsMonomicrobial biofilms of Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Streptococcus mutans and Pseudomonas aeruginosa and polymicrobial biofilms composed by C. albicans with each bacterium were formed for 48h and exposed for 5min to the plant extract. Murine macrophages (RAW 264.7), human gingival fibroblasts (FMM-1), human breast carcinoma cells (MCF-7) and cervical carcinoma cells (HeLa) were also exposed to the plant extract for 5min and the cell viability were analyzed by MTT, neutral red (NR) and crystal violet (CV) assays. Interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) produced by RAW 264.7 was quantified by ELISA, after 24h exposure to the plant extract, both in the absence and presence of lipopolysaccharide (LPS) from Escherichia coli. Genotoxicity of the plant extract was evaluated by micronucleus formation (MN) in 1000 cells. The results were analyzed by T-Test or ANOVA and Tukey's Test (P≤0.05).ResultsAll biofilms showed significant reductions in CFU/mL (colony-forming units per milliliter). Cell viability was above 50% for all cell lines. Anti-inflammatory effect on the synthesis of IL-1β and TNF-α was observed. The MN was similar or lower than the control group in all cells.ConclusionsT. vulgaris L. extract was effective against all biofilms, promoted high cell viability, anti-inflammatory effect and presented no genotoxicity.



http://ift.tt/2slX97E

Different expression patterns of Lin28 and Lin28b in mouse molar development

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Ning Dong, Yan Liu, Tiantian Zhang, Lin Zhao, Jiangang Tian, Jianping Ruan
ObjectiveThe RNA-binding proteins Lin28 and Lin28b are expressed in many developing tissues and are involved in the biosynthesis of the microRNA let-7 family and embryogenesis processes. However, their roles in mammalian tooth development remain ill-defined.DesignThe spatiotemporal expressions of Lin28 and Lin28b during mouse molar odontogenesis from day E11.5 to P21 were examined through immunohistochemistry and western blot analysis.ResultsBoth Lin28 and Lin28b were initially expressed in dental epithelium, but the expression patterns varied thereafter. Lin28 was expressed in tooth germ from early embryonic stages and was consistently expressed in the ameloblasts and odontoblasts throughout all stages of tooth development. However, positive staining of Lin28b gradually faded out with tooth germ development, before finally disappearing in tooth organ cells after birth.ConclusionsThese results indicate that Lin28 was spatiotemporally expressed in tooth germ throughout tooth development progression and may play an active role in ameloblast and odontoblast differentiation, as well as matrix secretion and the mineralization of enamel and dentin. Its paralogue Lin28b may have a distinct function in tooth germ formation.



http://ift.tt/2tEY72R

Role of fungi in chronic rhinosinusitis through ITS sequencing

Objective

Next-generation sequencing increases the sensitivity of fungal identification and may improve our understanding of the role that fungi play in sinus health and disease, which remains incompletely understood. We sequenced the internal transcribed spacer (ITS) amplicon to explore the role of the mycobiome in chronic rhinosinusitis (CRS).

Methods

Swabs were collected intraoperatively from the middle meatus of 90 patients (63 with CRS; 27 controls). DNA was extracted, and ITS amplicon concentration was measured using fluorometry. Internal transcribed spacer amplicons were sequenced on the Illumina MiSeq (Illumina Inc San Diego CA). Sequencing data were analyzed using QIIME.

Results

Using conventional detection techniques of culture and histology, fungi only were identified in nine of 63 (14.3%) CRS patients (fungus-identified group); the remaining 54 CRS patients and all controls did not have fungus identified using the traditional techniques. This fungus-identified group had a significantly higher average ITS concentration and a significantly lower Shannon's diversity index compared to the other two groups. The most abundant organism sequenced was Aspergillus (35.22% of all sequences). Multivariate analysis showed that positive fungal detection using traditional techniques and computed tomography (CT) double densities were the most important clinical predictors of a high fungal biomass, whereas Lund-Mackay score, polyps, eosinophilia, and eosinophilic mucus were not significant in comparison.

Conclusion

Fungal biomass estimated through ITS amplicon concentration correlated with traditional fungal detection techniques and CT double densities. Our results suggest that fungal dysbiosis only occurs in the sinuses of a selected subset of patients, and therefore could not be a universal determinant of sinus disease pathogenesis in all CRS patients.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2sme5Lc

Phosphorylated ribosomal protein S6 correlation with p21 expression and inverse association with tumor size in oral squamous cell carcinoma

Abstract

Background

The purpose of this study was to investigate the clinical relevance of phosphorylated ribosomal protein S6 (p-S6), a surrogate marker of mammalian target of rapamycin (mTOR) activation, and p21 in a series of 125 patients with oral squamous cell carcinomas (OSCCs).

Methods

Immunohistochemical analysis was performed to ascertain the phosphorylation status of p-S6 at Ser235/236 and Ser240/244, p21, and p53 protein expression.

Results

Expression of phosphorylated S6 protein on either serine 235/236 or serine 240/244 was detected in 83% and 88% tumors, respectively, and both of them were inversely and significantly correlated with the tumor size and local infiltration. Positive p21 expression was found in 91.5% of the cases, and was inversely correlated with tumor size. In OSCC, p21 expression correlates with p-S6 levels, a surrogate marker of mTOR activation, independently of p53 status.

Conclusion

Expression of both p21 and p-S6 was found to inversely associate with tumor size but not survival outcomes in patients with OSCC.

http://ift.tt/2tEzMtL

Osteocutaneous radial forearm free flap in nonmandible head and neck reconstruction

Abstract

Background

The osteocutaneous radial forearm free flap (RFFF) is a versatile flap primarily used to reconstruct composite defects involving the mandible. The purpose of this study was to describe our experience with this flap for nonmandible reconstruction.

Methods

All patients undergoing nonmandible osseous reconstruction with free-tissue transfer were reviewed. Patients with osteocutaneous RFFF reconstructions were evaluated. The retrospective review of all osteocutaneous RFFFs was performed from 1998 to 2014.

Results

One hundred forty-two nonmandible osseous reconstructions were performed. Twenty-five patients underwent nonmandible osteocutaneous RFFF reconstruction. Eleven patients failed previous nonmicrovascular reconstruction. Reconstruction was for defects of the: palatomaxillary complex (n = 15), orbitomaxillary complex (n = 4), nasomaxillary complex (n = 4), larynx (n = 1), and clavicle (n = 1). There were no flap compromises. Postoperative complications included: 2 partial intraoral dehiscences; 1 recipient-site infection; and 1 seroma. Eight reconstructions required secondary procedures to improve functional and/or cosmetic outcomes.

Conclusion

The osteocutaneous RFFF is a robust flap that can be used to reconstruct composite defects involving bone and soft-tissue beyond the mandible.

http://ift.tt/2slMlq6

Novel approach to maxillary reconstruction using osteocutaneous free tissue transfer with a customized stent

Abstract

Background

Computer-guided 3D virtual planning and customized templates are novel and effective methods aiding maxillary reconstruction, particularly during osteocutaneous free tissue transfer of complex defects. However, virtual planning and modelling is often expensive.

Methods

We present a new method to reconstruct complex defects with a surgical stent designed from presurgical casts. We present 2 patients who underwent this technique. Reconstruction in both cases was aided by a surgical stent fashioned preoperatively to approximate the anatomic dimensions of the defect, guiding the shape and orientation of the flap during inset to aid in dental rehabilitation.

Results

Surgery was performed without evidence of malocclusion, oronasal separation, or osteoradionecrosis with both patients undergoing successful rehabilitation and showing good postoperative oral intake.

Conclusion

Utilization of our novel surgical stent allowed reconstruction of complex maxillectomy defects and facilitated the design of a reconstructive flap without the need of pre-bent plates, cutting guides, or associated expenses.

http://ift.tt/2tEr4eV

Baroreceptor reflex failure: Review of the literature and the potential impact on patients with head and neck cancer

Abstract

Background

Baroreceptor dysfunction and reflex failure may occur after surgery affecting the carotid artery. The implications for patients undergoing treatment for head and neck cancer are not well described.

Methods

A literature search of PubMed was performed between March 2016 and May 2016. Search terms used individually and in combination included: "baroreflex failure," "carotid sinus sensitivity," "carotid endarterectomy," "carotid body tumor," and "head and neck cancer." Bibliographies of included articles were also reviewed for additional pertinent articles.

Results

There is evidence of baroreceptor failure in certain patients after interventions associated with the carotid artery, including carotid endarterectomy and carotid body tumor excision. Few studies have been performed investigating the potential effect of head and neck surgery treatment, including surgery and/or radiation, on baroreflex function.

Conclusion

Head and neck cancer treatment has the potential to cause baroreflex failure, and this is likely an underrecognized and underdiagnosed condition.

http://ift.tt/2sm1Y0P

Erratum to: Comparison of the Simple Patient-Centric Atopic Dermatitis Scoring System PEST with SCORAD in Young Children Using a Ceramide Dominant Therapeutic Moisturizer

http://ift.tt/2uFMgym

Fertilitätserhalt bei onkologischen Patientinnen

Zusammenfassung

Aufgrund der stetigen Optimierung von Chemo- und Strahlentherapien verbesserte sich die Überlebensrate bei Karzinomerkrankungen signifikant. Die onkologischen Behandlungen können Eierstock- und Hodengewebe dauerhaft schädigen. Dies belastet die Betroffenen und deren Partner zusätzlich. Eine zeitnahe, umfassende Aufklärung über Behandlungsmöglichkeiten bei drohendem Fertilitätsverlust ist deshalb von immenser Bedeutung. Neben der Kryokonservierung von Spermien und Hodengewebe beim Mann sind auch eine Kryokonservierung von Eierstockgewebe, befruchteten und unbefruchteten Eizellen nach ovarieller Stimulation neben einer Transposition der Ovarien vor Radiatio möglich. Eine protektive, hormonelle Therapie bei Frauen wird weiterhin kontrovers diskutiert. Das Netzwerk FertiPROTEKT wurde 2006 mit dem Ziel einer Bündelung der Expertise von Onkologen und Reproduktionsmedizinern, dem Aufbau einer flächendeckenden Versorgungsstruktur und der wissenschaftlichen Datenerfassung gegründet.

http://ift.tt/2tchTld

Restoring jawline contour with calcium hydroxylapatite: A prospective, observational study

Summary

Background

Jawline reshaping by replacing volume has become an indispensable component of modern facial rejuvenation.

Aim

To evaluate calcium hydroxylapatite (CaHA) for the treatment of an aging jawline in a routine setting.

Methods

Five investigators enrolled 35 subjects requesting jawline rejuvenation with CaHA. Injections were performed according to investigators usual practice. Baseline and post-treatment scores were evaluated using Merz Aesthetics Scales®. Follow-up visits took place at Day 30 (Day 60 for those with touch-up at Day 30), 180, and 360. Physician and patient satisfaction, esthetic impact of treatment, and adverse events were recorded.

Results

Improvements in jawline contour compared with baseline were statistically significant at each visit, with scores of 2.42 (moderate to severe sagging) at baseline, 1.02 (mild) at Day 30/60 (P≤.0001), 1.11 at Day 180 (P≤.0001), and 1.45 at Day 360 (P=.0015). Statistically significant improvements in marionette line scores were also observed. Investigators rated results as "improved" to "very much improved" in all subjects up to Day 180, and in 81% of subjects at Day 360. Satisfaction with treatment was very high. Adverse events were mostly mild and related to either the procedure or injection technique.

Conclusion

CaHA is a very effective agent for restoring jawline contour in routine practice and is associated with high levels of physician and patient satisfaction.

http://ift.tt/2tLXaWC

Gefährliche Kosmetikprodukte in Deutschland

Zusammenfassung

Hintergrund

Kosmetische Produkte unterliegen der europäischen Kosmetikverordnung. Danach dürfen sie bei Anwendung unter „normalen oder vernünftigerweise vorhersehbaren Bedingungen" die menschliche Gesundheit nicht schädigen. Gefährliche kosmetische Produkte werden von den EU-Mitgliedstaaten an die Europäische Kommission gemeldet und in der Datenbank des europäischen Schnellwarnsystems RAPEX gelistet.

Material und Methoden

Die Meldungen aus Deutschland über gefährliche Kosmetikprodukte aus den Jahren 2005 bis 3/2017 in der europäischen RAPEX-Datenbank wurden systematisch ausgewertet.

Ergebnisse

Im genannten Zeitraum wurden aus Deutschland 157 gefährliche Kosmetikprodukte gemeldet. Die häufigsten Produktkategorien waren Bleichcremes (24,2 %) wegen des Gehalts an Hydrochinon, Quecksilber oder Glukokortikosteroiden, Cremes/Lotionen/Gele (10,8 %) überwiegend wegen mikrobiologischer Kontaminationen, Hennaprodukte (10,2 %) wegen sensibilisierender Konzentrationen von Paraphenylendiamin und Nagelklebstoffe (8,9 %) wegen hoher Gehalte an Methylmethacrylat.

Diskussion

Gefährliche Kosmetikprodukte scheinen angesichts des hohen Marktvolumens von Kosmetika selten zu sein, auch wenn die Gesamtzahl der den Meldungen zugrunde liegenden behördlichen Untersuchungen nicht bekannt ist. Dermatologen sollten bei einem Verdacht auf Gesundheitsschädigungen durch Kosmetikprodukte die zuständigen Überwachungsbehörden informieren, damit die Produkte untersucht und ggf. vom Markt genommen werden können.

http://ift.tt/2sHxc1A

Ultra-short-course booster is effective in recurrent grass pollen–induced allergic rhinitis

Abstract

Background

A relevant proportion of allergic rhinitis (AR) patients experience recurrent symptoms after successfully completing allergen immunotherapy (AIT). This prospective, controlled, non-interventional study used internationally standardised instruments to determine the clinical effects of a preseasonal, ultra-short-course booster AIT on clinical outcome parameters.

Methods

This two-arm study included patients aged ≥12 years with recurrent grass pollen–induced seasonal AR who had completed a successful course of any grass pollen AIT at least five years before enrolment. Overall, 56 patients received one preseasonal short-course booster AIT using tyrosine-absorbed grass pollen allergoids containing the adjuvant monophosphoryl lipid A (MPL^®); 51 control patients received symptomatic medication. The combined symptom and medication score (CSMS) was recorded in the (peak) grass pollen season. Furthermore, concomitant (antiallergic) medication use, the patients'state of health, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) results, and safety/tolerability of the treatment were assessed.

Results

The CSMS in the peak grass pollen season was significantly lower in the booster AIT group (Δ=38.4%, P<0.01). Moreover, significantly more patients in this group used no concomitant antiallergic medication throughout the peak grass pollen season. Twice as many patients in the booster AIT group as in the control group reported having a better state of health than in the preceding season. RQLQ results showed significant differences favouring the booster AIT. The booster AIT was generally well tolerated, with only 2 patients reporting mild, grade 1 systemic adverse events.

Conclusion

Booster AIT using tyrosine-absorbed allergoids containing the adjuvant MPL^® effectively prevents re-occurrence of symptoms in patients with grass pollen–induced AR.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tkKenv

An Unusual Presentation of Tapia Syndrome Mimicking a Partial Wallenberg Syndrome Following Anterior Cervical Spine Surgery.

No abstract available

http://ift.tt/2tLEJ4A

Feasibility of Protective Ventilation During Elective Supratentorial Neurosurgery: A Randomized, Crossover, Clinical Trial.

Background: Traditional ventilation approaches, providing high tidal volumes (Vt), produce excessive alveolar distention and lung injury. Protective ventilation, employing lower Vt and positive end-expiratory pressure (PEEP), is an attractive alternative also for neuroanesthesia, when prolonged mechanical ventilation is needed. Nevertheless, protective ventilation during intracranial surgery may exert dangerous effects on intracranial pressure (ICP). We tested the feasibility of a protective ventilation strategy in neurosurgery. Materials and Methods: Our monocentric, double-blind, 1:1 randomized, 2x2 crossover study aimed at studying the effect size and variability of ICP in patients undergoing elective supratentorial brain tumor removal and alternatively ventilated with Vt 9 mL/kg-PEEP 0 mm Hg and Vt 7 mL/kg-PEEP 5 mm Hg. Respiratory rate was adjusted to maintain comparable end-tidal carbon dioxide between ventilation modes. ICP was measured through a subdural catheter inserted before dural opening. Results: Forty patients were enrolled; 8 (15%) were excluded after enrollment. ICP did not differ between traditional and protective ventilation (11.28+/-5.37, 11 [7 to 14.5] vs. 11.90+/-5.86, 11 [8 to 15] mm Hg; P=0.541). End-tidal carbon dioxide (28.91+/-2.28, 29 [28 to 30] vs. 28.00+/-2.17, 28 [27 to 29] mm Hg; P

http://ift.tt/2ukPPL0

Hemangiopericytoma of the thoracic spine: a case report

Abstract

Hemangiopericytoma (HPC) has been described to be aggressive and potentially a malignant tumour. We report a rare case of a 63-year-old Chinese male who presented with primary intradural extramedullary HPC of the thoracic spine. The main presenting complaint was gradual progression of back pain, associated with paraparesis and sensory deficit of lower limbs. He had MRI thoracolumbar with contrast which showed T9 lesion compressing on spinal cord and oedema, he was then operated upon and histopathology report confirmed a thoracic spine HPC. A T8/9 laminectomy and excision of intradural extramedullary lesion was performed, tumour section was sent for frozen section study, and more tissue was sent for paraffin studies and additional immunohistochemical staining. Surgical resection is most commonly performed, radiotherapy remains debatable. In this report, we discussed another rare case of primary spinal HPC to be added into the literature.

http://ift.tt/2tLfpeX

Pilomatrixoma located on the cruris: an uncommon localization

Abstract

Pilomatrixoma is a benign tumor of hair follicle matrix cells. The majority of all pilomatrixomas were reported to affect the head–neck region and rarely the upper extremity. We present a case of left-leg pilomatrixoma, which is a extremely rare localization, in a 10-year-old boy.

http://ift.tt/2tLsuop

Vacuum-assisted closure therapy after resection of giant basal cell carcinoma of the scalp

Abstract

Management of complicated wounds is a challenge in head and neck reconstruction. Although the negative pressure wound therapy or wound vacuum-assisted closure has been widely used in complicated wounds and shows promising results, its application in the head and neck region after reconstruction for the head and neck cancer is rarely presented. A 77-year-old woman underwent a radical resection of an extensive basal cell carcinoma of the scalp and forehead involving the periosteum, where classic reconstruction was difficult, but successfully treated with negative pressure wound therapy. Negative pressure wound therapy is an efficacious tool in cases of complex and extensive defects, when we expect immediate reconstruction with poor results, as would be probable with this scalp lesion.

http://ift.tt/2tLCb6y

Thyroid Disorders in Central Ghana: The Influence of 20 Years of Iodization

Background. Ghana began mandatory iodization of salt in 1996. This study compares the prevalence of thyroid disorders before and after the introduction of iodization. Methods. This is a retrospective study of thyroid cases from the middle belt of Ghana between 1982 and 2014. To demonstrate a link between iodization and hyperthyroidism and autoimmunity, we compared the prevalence of hyperthyroidism and autoimmune thyroid disorders before and after the iodization programme. Results. A total of 10,484 (7548 females, 2936 males) cases were recorded. The rate of thyroid cases seen was 343/100,000. Nontoxic nodular goiters (25.7%) and toxic nodular goiters (22.5%) represented the second commonest thyroid disorders recorded. The prevalence of hyperthyroid disorders seen after 1996 was significantly higher than the prevalence seen before the iodization (40.0 versus 21.1%, ). The prevalence of autoimmune disorders recorded after iodization was significantly higher than that before the iodization programme started (22.3% versus 9.6%, ). Conclusions. This study has revealed a significant increase in thyroid admissions in Central Ghana over the decades. A connection between iodine fortification and iodine-induced hyperthyroidism and between iodine fortification and autoimmune thyroiditis has been shown in this study.

http://ift.tt/2uEZPht